Title:Treating COPD in Older and Oldest Old Patients
Volume: 21
Issue: 13
Author(s): Andrea Corsonello, Simone Scarlata, Claudio Pedone, Silvia Bustacchini, Sergio Fusco, Anna Zito and Raffaele Antonelli Incalzi
Affiliation:
Keywords:
Older, chronic obstructive pulmonary disease (COPD), long-acting antichilinergics (LAMA), long-acting beta agonists (LABA),
comorbidity, adherence.
Abstract: The treatment of older and oldest old patients with COPD poses several problems and should be tailored
to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological
systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed
the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting betaagonists
(LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered
that pharmacological response and safety profile may vary significantly in older patients with multimorbidity.
Their association with inhaled corticosteroids is recommended only for patients with severe or very severe airflow
limitation or with frequent exacerbations despite bronchodilator treatment. In hypoxemic patients, long-term
oxygen therapy (LTOT) may improve not only general comfort and exercise tolerance, but also cognitive functions and sleep. Nonpharmacological
interventions, including education, physical exercise, nutritional support, pulmonary rehabilitation and telemonitoring
can importantly contribute to improve outcomes. Older patients with COPD should be systematically evaluated for the presence of risk
factors for non-adherence, and the inhaler device should be chosen very carefully. Comorbidities, such as cardiovascular diseases,
chronic kidney disease, osteoporosis, obesity, cognitive, visual and auditory impairment, may significantly affect treatment choices and
should be scrutinized. Palliative care is of paramount importance in end-stage COPD. Finally, treatment of COPD exacerbations has been
also reviewed.
Therapeutic decisions should be founded on a careful assessment of cognitive and functional status, comorbidity, polypharmacy, and agerelated
changes in pharmacokinetics and pharmacodynamics in order to minimize adverse drug events, drug-drug or drug-disease interactions,
and non-adherence to treatment.
